Overview
Please note: This is a static site which serves as a demonstration of the first week of content from PHRM7203.
Each line break represents a new 'page' and each numbered section represents a different section of the UQ Extend site.
Screenshots of the preview site are provided as an appendix in this page
Welcome to Week 1 of PHRM1203. During this week you will be learning about the principles of medication safety and why medication errors occur in practice. There are some videos to watch and activities to do that will assist you in developing your knowledge about the impact that medication incidents can have on patients, their families and you as practitioners.
Week 1 Learning Outcomes
On completion of week 1 you will be able to:
- Describe the key principles of medication safety.
- Explain why medication errors occur.
- Explain the significance of medication errors.
- Reflect on medication incidents, errors and near misses in practice.
- Describe some of the approaches to medications safety to prevent errors.
- Describe some standardised systems to support medication safety such as the National Inpatient Medication Chart.
- Describe common high risk medications and approaches to reduce medication incidents associated with these.
- Describe tools that evaluate medication administration by nurses and midwives to reduce errors.
2. Improving Medication Safety Through Effective Communication and Teamwork
Video: Medication Safety: A Patient's Story
Watch this video about medication safety: Helen Haskell, the founder and president of Mothers Against Medical Error, shared the story of her son, Lewis Blackman, at the "Improving Medication Safety Through Effective Communication and Teamwork." Conference in 2011.
Activity: Short Answer Question - Medication Safety
Write down three key messages that you will take away from watching this video
What do you know about Medication Safety?
Activity: What do you know about medication Safety?
Answer the following questions
Question 1
Is the following statement True or False?
Medicines are associated with a higher incidence of errors than other healthcare interventions
- True
- False
Question 2
Is the following statement True or False?
Medicines are associated with a higher incidence of adverse events than other healthcare interventions?
- True
- False
Question 3
From the following statements, choose the correct answer.
- Up to 30% of medication incidents are potentially preventable
- Up to 40% of medication incidents are potentially preventable
- Up to 50% of medication incidents are potentially preventable
Question 4
From the following medications, choose those that are considered high risk medications? (Multiple response)
- Anticoagulants
- Antimicrobials
- Chemotherapy
- Opioids
- Potassium
- Insulin
Question 5
From the following patients choose those who are considered at a higher risk of a medication related adverse effect. Choose all that apply.
- A patient admitted to hospital as a result of a medicine-related problem
- A patient taking multiple medicines or high-risk medicines
- A patient taking medicines prescribed by multiple clinicians
- A patient with suspected medication adherence problems
- A patient with a chronic disease
- A patient with a disability or impairment (for example, cognitive impairment)
- A patient over 65 years
- A patient with a known allergies
Information sources for medicines
Health professionals are expected to use accepted resources to justify their professional judgements
What are some information sources that are acceptable for health professionals to use?
Word Cloud Activity
Key Resources
Australian Medicines Handbook: Information about specific medicines which is published and reviewed independently (e.g. doses, directions, contraindications and interactions, counselling points)
Therapeutic Guidelines: Information about medical conditions published and reviewed independently (e.g. treatment guidelines; which drugs to use for specific conditions)
eMIMs: Information about specific medicines which is published by drug sponsors (pharmaceutical companies)
There are a number of handy links at this library webpage.
The regulation of medicines
Medicines are regulated as a way of ensuring that they are used safely.
Most of the time, this means putting in place restrictions on the use of specific medicines.
The Therapeutic Goods Administration is the primary regulator of medicines in Australia.
They maintain the scheduling of medicines in Australia (the categories which determine how accessible a medicine is).
They also maintain a list of medicines and categorise them based upon their safety in pregnancy and breastfeeding.
Medicines scheduling
In Australia, we use the following schedules for medicines:
| Schedule | Meaning |
|---|---|
| Schedule 1 | Not currently in use |
| Schedule 2 | Pharmacy Medicine |
| Schedule 3 | Pharmacist Only Medicine |
| Schedule 4 | Prescription Only Medicine OR Prescription Animal Remedy |
| Schedule 5 | Caution |
| Schedule 6 | Poison |
| Schedule 7 | Dangerous Poison |
| Schedule 8 | Controlled Drug |
| Schedule 9 | Prohibited Substance |
| Schedule 10 | Substances of such danger to health as to warrant prohibition of sale, supply and use |
Note: Schedules 2, 3, 4 and 8 (and unscheduled) are the only schedules used for medicines/vitamins
3. Medication Safety - An Introduction
Watch the following video on medication safety which covers the following topics:
- Terminology
- Adverse Drug Reactions
- Mediation Management Pathway
Methotrexate case study
This case study steps you through an event that describes how medication incidents can happen. After reading each step, click on the next slide to find out what happened next.
## Short answer question: Methotrexate Case Study Detail three key learnings that you will take away from this case study
Medication management pathway
4. Case studies
Read through the following three case studies and using the Medication Pathway discuss:
- Where in the cycle did the error occur?
- Where in the cycle was the error picked up and corrected?
Case 1
On reviewing a patient’s medication chart the pharmacist notices that the patient has a history of anaphylaxis to Angiotensin-converting enzyme (ACE) inhibitors. The patient has been prescribed a new medication - ramipril 2.5mg daily for blood pressure control. The pharmacist contacts the prescriber, and the medication is changed to a different class of blood pressure medication.
1. Where in the cycle did the error occur?
2. Where in the cycle was the error picked up and corrected?
Case 2
A midwife is about to administer a prescribed dose of 600mg of benzylpenicillin for prevention of Group B streptococcal disease. The order is for 600mg every 4 hours until birth. The midwife checks the protocol and realises the recommend dose is 1.8grams every 4 hours until birth. The midwife contacts the prescriber and the medication order is changed.
3. Where in the cycle did the error occur?
4. Where in the cycle was the error picked up and corrected?
Case 3
A patient complains of rash on their face and neck – 10 minutes after a vancomycin infusion has been commenced for an MRSA bacteraemia infection. The patient notifies the nurse who discontinues the infusion. The nurse checks the protocol and realises the rate of infusion has been set to be infused over 20mins instead of 120 minutes. The nurse contacts the prescriber and the medication order is changed.
5. Where in the cycle did the error occur?
6. Where in the cycle was the error picked up and corrected?
Why do medication errors occur?
Watch the following video on medication errors which covers the following topics:
- Significance and Impact
- Why errors occur
- Medication incidents errors and near misses in practice
Activity: Word Cloud
Use one or two words that could describe how or why medication errors can occur. Type your words in the boxes below to form a word cloud.
Word cloud activity
Reading activity: A Better Prescription for Preparing Nursing Students for Practice
Read the following white paper A Better Prescription for Preparing Nursing Students for Practice.
A White Paper Project Funded by WellStar School of Nursing WellStar College of Health and Human Services Kennesaw State University, Kennesaw, GA
Activity: Short answer question - medication errors
Choose three different causes of medication errors outlined in the white paper and write a short 3-4 sentence reflection on each. About how you, as a nurse or a midwife might prevent these causes in your own practice.
| Causes | Reflection |
|---|---|
| e.g. Missing information about the patient. | e.g. I would check the patients ID to make sure i had the correct patient. I would look for the allergy history and check with the patient if they had any allergies before giving a medication. I would think about the indication of the prescribed medication and ask myself if it was appropriate for the patient. |
5. Medication safety approaches
Watch the following video on Medication Safety Approaches
Activity: Short answer
Question 1
Describe 3 approaches to medication safety that you identified from the video.
Question 2
Electronic Medication Management (EMM) Systems provide greater safety and reduce medication incidents compared to paper based system.
Complete the table by stating what the acronym APINCH stands for. The first one has been completed as an example
| Meaning | |
|---|---|
| A | Antimicrobials |
| P | |
| I | |
| N | |
| C | |
| H |
Activity
Publications and Resources:
- Medication Charts
- National Inpatient Medication Chart
- Adults
- Acute
- And download a copy of the NIMC (acute)
Familiarise yourself with the medication chart and locate the following areas on the chart:
- Once only and nurse initiated medicines and pre-medication
- Telephone orders
- Regular medicines
- Variable dose medicine
- VTE prophylaxis
- Warfarin
- As required Medicines
Look at the reasons for not administering a medication in the middle of the chart and complete the table. The first line has been given as an example.
| Meaning | |
|---|---|
| A | Absent |
| F | |
| R | |
| V | |
| L | |
| N | |
| W | |
| S |
Medication Administration Evaluation and Feedback Tool (MAEFT)
The Medication Administration Evaluation and Feedback Tool or (MAEFT) has been developed as a tool to assist nurses and midwives know what the safest way is to administer medicines and prevent opportunities for errors to occur.
The nurses and midwives use the MAEFT to reflect on the criteria and see if it is something they usually do. They are then observed by a colleague giving a medication to a patient and then they have a discussion to identify things they have done well or where there are opportunities to improve in order to reduce the chance of making an error and harming the patient.
The MAEFT has 2 sections:
- 11 Clinical steps that incorporate the 6 rights (including the right to refuse to give if the other 5 are not correct.)
- 11 Procedural steps to ensure the medicine is administered safely, such as monitoring, hand hygiene, 2-person (clinician) check, patient engagement and signing after giving.
There is a Self-Assessment Scale of how frequently the nurse/midwife thinks they conduct each criteria. This is on a scale of:
- Rarely conduct it
- Sometimes
- Usually
- Consistently
- It isn't applicable in their setting
Activity
Watch the following video of a scenario of a nurse administering medication to Mr Oliver Brown and then complete the activities below
When observed by their colleague giving a medicine it is documented as Yes they have completely conducted the criteria or No if they have not. In some instances, for a medication or the setting criteria may not be applicable.
Using the MAEFT document YES or NO
- Whether the nurse performed each of the 22 criteria
- If NO, note what they didn’t do completely
6. Summary
Here is a summary of the key points from this week:
- The medication management pathway identifies the various steps in the provision of safe and effective quality use of medicines for patients.
- Key principles of medication safety.
- Outlined some reasons why medication errors can occur.
- We have also considered the significance and impact of medication errors/ medication errors can be multifactorial and occur due to organisational or human factors.
Further, this week we have outlined some of the approaches that have been developed and put into clinical practice to prevent medications errors and enhance safety. Some of these have included standardised systems such as the standardised medication charts. We have also looked at high risk medications and approaches to reduce medication incidents associated with these. Finally, we have presented tools that evaluate medication administration, specifically the MAEFT that has been developed to observe, evaluate and provide feedback to nurses and midwives on medication administration.
Appendices
Screenshot overview
